Placement of middle ear ventilation tubes in the tympanic membrane is a common pediatric surgical procedure for the treatment of middle ear infection or otitis media. Also known as tympanostomy tubes or pressure equalizing (PE) tubes, the procedure involves creating an incision (i.e., a myringotomy) in the tympanic membrane and placing a tube in the incision to allow ventilation, pressure equalization and drainage from the middle ear out through the ear canal. The tube can remain in the ear for months or years.
A tube is placed in the tympanic membrane via visualization through a microscope. A sharp blade is used to create the incision and various surgical instruments are used to manipulate the tube into the incision. In the confined space of the ear canal, placement of the tube can be difficult, especially in aligning the flange at one end of the tube with the incision and the need for multiple different surgical instruments to perform the procedure. It is also not uncommon for the tube to dislodge from the surgical instrument or for it to accidentally extract from the tympanic membrane before being fully seated, requiring multiple attempts before successful placement is achieved. In addition, the large retention flanges included in most tubes make them difficult to maneuver in the ear canal and will actually block the clinician's view of the incision site.
Because the middle ear is highly innervated, repeated manipulation of the tympanic membrane is painful enough that patients, especially young children, who make up the majority of tube recipients, require general anesthesia. Such a drug therapy is costly and poses additional risks.
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